Shafik A
Dis Colon Rectum. 1979 Nov-Dec;22(8):539-49. doi: 10.1007/BF02587000.
The anatomy of the levator hiatus and tunnel has been studied, aiming at the elucidation of their functional role in mechanisms of defecation, urination, and continence. The material comprised 25 cadavers studied by dissection and serial histologic sections. The levator hiatus occupies the anterior portion of the levator plate which consists of two "crura," that bound the hiatus, and two "lateral masses." Three crural patterns could be identified: classic, crural overlap and crural scissor. The levator tunnel is a muscular tube which surrounds the intrahiatal organs along their way down from the levator hiatius to the perineum. It is double sheathed, with an inner coat of the suspensory sling and an outer of the puborectalis. Both coats are of striped muscle bundles. The inner coat is a tunnel "dilator," whereas the outer is a tunnel "constrictor." The puborectalis not only acts as a "common tunnel" sphincter but provides an "individual" sphincter for each intrahiatal organ. A detailed study of the hiatal ligament which firmly binds the levator plate to the intrahiatal organs is presented. A "tunnel septum" could be identified to line the levator tunnel, and separate it from the intrahiatal organs. Its surgical significance as a landmark for mobilizing the intrahiatal organs from within the tunnel is stressed. The levator plate consists of two functionally separate zones: a lateral "visceral support" zone and medial "dilator" one. The double sphincteric control provided to each intrahiatal organ by the "individual" and "common" sphincters would suggest that unless both sphincters are destroyed, continence could be maintained by either. The role of the "levator complex" which comprises levator crura, tunnel and hiatal ligament in fixation of intrahiatal structures, as well as in mechanisms of defecation, urination, and continence, is discussed. The understanding of the anatomic details of the levator hiatus and tunnel could be of value in mobilizing the intrahiatal structures from within the levator tunnel with preservation of their voluntary sphincteric mechanism.
对提肌裂孔和提肌管的解剖结构进行了研究，旨在阐明它们在排便、排尿和控尿机制中的功能作用。研究材料包括25具尸体，通过解剖和连续组织切片进行研究。提肌裂孔位于提肌板的前部，提肌板由两个界定裂孔的“脚”和两个“外侧块”组成。可识别出三种脚的形态：经典型、脚重叠型和脚交叉型。提肌管是一个肌性管道，它沿着裂孔内器官从提肌裂孔向下至会阴的路径环绕它们。它有双重鞘膜，内层为悬吊吊带，外层为耻骨直肠肌。两层均由横纹肌束组成。内层是管道“扩张器”，而外层是管道“收缩器”。耻骨直肠肌不仅作为“共同管道”括约肌起作用，还为每个裂孔内器官提供“单独”的括约肌。本文对将提肌板牢固地与裂孔内器官相连的裂孔韧带进行了详细研究。可识别出一个“管道隔膜”，它衬于提肌管内，并将其与裂孔内器官分隔开。强调了其作为从管道内游离裂孔内器官的标志的手术意义。提肌板由两个功能上分开的区域组成：外侧的“内脏支持”区和内侧的“扩张器”区。“单独”和“共同”括约肌为每个裂孔内器官提供的双重括约肌控制表明，除非两个括约肌都被破坏，否则任何一个都可维持控尿功能。讨论了由提肌脚、管道和裂孔韧带组成的“提肌复合体”在固定裂孔内结构以及排便、排尿和控尿机制中的作用。了解提肌裂孔和提肌管的解剖细节对于在保留其自主括约肌机制的情况下从提肌管内游离裂孔内结构可能具有重要价值。
